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Encephalopathy
Pathogenesis
No
Pathogenesis
Bypasses liver
Return to heart
Toxic substances enters brain
Impending hepatic coma
Classification of hepatic
encephalopathy
Classification of hepatic
encephalopathy
Type
Aetiological factors
A(20%)
Viral hepatitis,
Alcoholichepatitis,
Drug reacns &overdose.
B(100%)
C(75%)
Diuresis,
Haemorrhage,Paracentesis,
Diarrhoea,Surgery,Sedatives,
Sepsis,Constipation.
Neurotansmitters implicated in
HE
intestinal protein/bacteria
reduced hepatic removal
reduced muscle metabolism
NH3
EFFECTS:
Astrocyte damage
glutamine accumulates
BBB permeability (ICP)
Manganese &
false neurotransmitters
Blood
Investigations
CSF
analysis
:cell count,protein,
glutamatic acid
Electroencephalogram :b/l synchronous
slowing of waves
Evoked potentials
Brain scans
Magnetic resonance spectroscopy
Neuropathology
Treatment of Hepatic
encephalopathy
Broadly divided into 3 areas
1. Identification & treatment of ppt
factors
2. Interventions to reduce the
production of & absorption of gut
derived ammonia & other toxins
3. Prescription of agents to modify
neurotransmitters
Antibiotics :
Neomycin (4-6 gr /day )for 5-7 days in acute cases
reduces ammonia formation in GIT
(careful in RF)
Metronidazole(200 mg Qid )
Rifaximin, or brand name Xifaxan, a derivative of rifamycin at a dose of 400
mg taken orally 3 times a day was as effective as lactulose or lactilol at
improving hepatic encephalopathy symptoms. Similarly, rifaximin was as
effective as neomycin and paromomycin. Rifaximin was better tolerated
than both the cathartics and the other nonabsorbable antibiotics. . There are
also concerns regarding the cost-effectiveness of the medication.
Purgation by enemas esp phosphate
Erradication of H. pylori.
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